Health and Social Care

Jim Dowd Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Jim Dowd (Lewisham West and Penge) (Lab)]

It is an unexpected pleasure to see you in the Chair, Mr Howarth—although Mr Speaker is now taking over just as I say that. It is a pleasure to serve under you both. The maiden speeches that have been given this afternoon have been uniformly excellent, and I am sure that they betoken a bright parliamentary future for those Members. To the hon. Member for Colchester (Will Quince), may I say that I knew Bob Russell well for the 18 years he served here. Our offices were a few doors apart on the Upper Committee corridor. If the hon. Gentleman can serve the people of Colchester one tenth as well as Sir Bob Russell did, he will be doing very well indeed.

In my reflections on the Queen’s Speech, I would like to say something about health, if I have the time, but there are other things that I want to say before that. First, perhaps surprisingly, I welcome the inclusion of the European Union Referendum Bill. I have been a supporter of a referendum on our future relationship with Europe, and a few years ago served on the Committee for the European Union (Referendum) Bill, which was introduced by the hon. Member for Stockton South (James Wharton). I noticed that he retained his seat with a swing of 4.5% to the Conservatives, as opposed to the 2% swing to Labour in Stockton North, and think that it might have something to do with the role he played in picking up the Bill. It was a reward for his effort.

The Bill was known by the denizens of the fourth estate as the Wharton Bill, but that is not actually true. It was a No. 10 Bill that the hon. Gentleman picked up having been drawn first in the private Members’ ballot. The Committee was an interesting experience, not to mention entertaining, because it was entirely led by the Minister for Europe, the right hon. Member for Aylesbury (Mr Lidington). The hon. Member for Stockton South said not a word until the final sitting and the pleasantries that conclude every Committee stage. We were also entertained by the bizarre sight of the Prime Minister having to pay obeisance to the Eurosceptic right wingers on the Committee, to whom he was in thrall, by sitting in the Public Gallery of the Committee Room on a Tuesday evening. I have tried to check whether any previous Prime Minister has been forced to suffer such humiliation, but so far I have drawn a complete blank. The Bill was a device to hold the Tory party together more than anything else, and it foundered as a consequence.

My support for a referendum is based on the belief that our relationship with and position in the EU needs to be clarified, and only the electorate at large can do that. Polls show majority support for the referendum, even among those who would vote for the UK to remain a member of the EU. I felt that my party’s position at the general election—refusing to support a referendum on the grounds of uncertainty—was always untenable. The only way to remove uncertainty is to deal with it, not to ignore it. Denying people a say on the grounds that they might come up with the wrong answer is unworthy of any truly democratic party. I am neither a Europhile nor a Europhobe; I am what I prefer to call a Europragmatist. I believe that the interests of this country, its economy and its people are best served by remaining in the EU, but I see that there can be life outside the EU, even though I do not think that that is the optimal solution.

I speak as someone—I think I am in the minority in the House—who actually voted in the 1975 referendum, and voted no. However, I offer the Prime Minister a word of caution. Harold Wilson devised the referendum in 1975 largely as a device to hold the Labour party together, and it did so in the short term, but that did not endure. It also resulted in defeat at the next general election in 1979, which left the Labour party languishing on these Opposition Benches for the next 18 years.

Childcare was mentioned in the Queen’s Speech and it is immensely important to hundreds of thousands of families. The Labour party promised an extra 10 hours of childcare on top of the current 15 hours, and the Conservatives promised an additional 15 hours, so there is no real difference on the principle. Everything revolves around the practicalities of capacity and cost.

At the moment, it is estimated that under the 15-hour scheme there is a 20% funding shortfall. The average amount that most local authorities pay is £3.88 per hour, but the true cost to those providing the service is 70p an hour more than that. The Family and Childcare Trust, the National Day Nurseries Association and the Pre-school Learning Alliance have all expressed grave reservations about what is being proposed, as well as saying that it is necessary to get things right.

Just a week after the general election I received a letter from somebody who runs a Montessori nursery in my constituency. He is actually a constituent of my hon. Friend the Member for Lewisham East (Heidi Alexander) and also sits on the executive of the private providers, Bromley council partnership group, which represents about 200 private providers in the borough of Bromley. He wrote:

“The reason so many of us are concerned is that MPs and certainly a minister in charge of this portfolio must know how private providers in London and South East are currently subsidising the ‘free’ 15 hours with the additional time purchased by families above the 15 hours at a rate more in line with the real cost of provision. You will also know that raising the ‘free’ entitlement to 30 hours will almost eliminate this approach and I am sure you will not insult our intelligence by suggesting the promised increases in the Government’s rate of funding will get anywhere near replacing this revenue.”

[Mrs Hodgson]

My hon. Friend is making some extremely valuable points in expanding on what I said towards the end of my speech. Is he as concerned as I am that the Government have not come forward with any proposals about how they will pay for this scheme? Indeed, the only benefit that we have heard might be at risk is child benefit. Is he also worried about that?

[Jim Dowd]

Yes—I am worried about anything that has not been specifically stated in the Queen’s Speech. I know that the Government have engaged in a review of the implications of this proposal, but they should have engaged in that before promising anything. To put the promise up front and then say, “Well, we’ll sort something out afterwards”, is a recipe for chaos.

What will happen if the Government are not careful is that we will move to the disgraceful position that we have had for many years in residential care for the elderly, whereby it is the private payers who subsidise the local authority residents, because the local authority residents’ rates are fixed and the private payers have to pay a premium on top of those rates. If that is what this proposal results in, it will be a complete and utter disgrace, and it will not work because there is not the capacity in the private nursery sector for everybody to take advantage of it.

Finally, the reservations of the hon. Member for South Dorset (Richard Drax), who is not in his place, about the right to buy for housing association tenants are entirely justified. That proposal is little more than a scandalous bribe to those who are already adequately housed. A discount of anything up to £102,000 in London is not only grossly unfair but an insult to those in the private sector who would dearly love to be given £100,000 to buy a house or to rent. This will add nothing at all; it does nothing to deal with the housing crisis, either here in London or anywhere else. It is a sordid Government-sponsored corruption scheme worthy of FIFA.

Princess Royal University Hospital

Jim Dowd Excerpts

Wednesday 25th March 2015 Westminster Hall

[Jim Dowd (Lewisham West and Penge) (Lab)]

I am grateful both to you, Mr Betts, and to the Minister for agreeing to my proposition that I speak for 10 minutes and my hon. Friend the Member for Lewisham East (Heidi Alexander), who is equally concerned about these matters, may speak for five minutes; the Minister will have the prerogative of the usual arrangements for ministerial responses.

The reason I have raised this matter is that in south-east London generally and in Lewisham in particular we have been around this course before, and know exactly where it wound up then. I will be candid from the off: I am deeply suspicious of the whole process currently being embarked upon by Monitor and of the involvement of the Princess Royal university hospital at Orpington and King’s College hospital trust. I hope the Minister will be able to provide me with some assurances that will assuage my fears about this matter.

I will explain why. On Tuesday 24 July 2012—hardly a day that will live in infamy, but one that certainly remains clear in my mind—we had a meeting at the Department of Health with the then Secretary of State, the right hon. Member for South Cambridgeshire (Mr Lansley). My hon. Friend the Member for Lewisham East was there, as were Members for constituencies in the boroughs of Greenwich and Bromley, including the hon. and gallant Member for Beckenham (Bob Stewart). I see that the hon. Member for Bromley and Chislehurst (Robert Neill) is in his place today; I cannot remember whether he was also at the meeting, but other Members certainly were. The meeting concerned the future of the South London Healthcare NHS Trust, which then consisted effectively of the Queen Elizabeth hospital in Woolwich, the Princess Royal university hospital in Orpington, which I chose as the title for the debate today, and Queen Mary’s hospital in Sidcup.

Members for constituencies in the boroughs of Bexley, Bromley and Greenwich were quite rightly invited to that meeting. As I said, my hon. Friend the Member for Lewisham East and I were both invited, even though Lewisham hospital was not part of the South London Healthcare trust. No one else from south-east London—no Members for constituencies in Lambeth or Southwark—was invited or present, although, strangely enough, they were included in the later stages of the discussions by the current Secretary of State for Health after Mr Matthew Kershaw, the trust’s special administrator, had made an initial report. His report essentially looked at the considerable downgrading—some would say the destruction—of Lewisham hospital as the answer to the problems at the Princess Royal, Queen Elizabeth and Queen Mary’s hospitals.

--- Later in debate ---

On resuming—

[Jim Dowd]

I was talking about the fabled meeting in July 2012—two and a half years ago. When the Secretary of State and the trust special administrator said that the answers to the problems of the then South London Healthcare NHS Trust did not lie within its own boundaries, I knew that what they had in mind was effectively the evisceration of Lewisham hospital. For reasons that have eluded me for decades and more—I used to be on the health authority of Lambeth, Southwark and Lewisham, and the district health authority for Lewisham and north Southwark—various elements of NHS London have always had Lewisham hospital in their sights. There was once a plan for there to be only four accident and emergency and general hospitals in south-east London: St Thomas’, King’s, PRUH and Queen Elizabeth; there was no room for Lewisham. I do not know why the various NHS powers think Lewisham is such an encumbrance. The service it provides to its residents and the pressure it relieves from the other hospitals around south-east London are proof positive of its value.

The morning of 5 March dawned—I was quite delighted about that, because it was my birthday. At 9.25 am, I received an e-mail from Monitor, explaining that,

“Monitor is opening an investigation at King’s College Hospital NHS Foundation Trust to find a lasting solution to long-standing problems at the Princess Royal University Hospital…The regulator is concerned that some patients are waiting too long for A&E treatment”—

nothing unusual there. Not one of the hospitals in south-east London—not St Thomas’, over the river, not PRUH, not Queen Elizabeth, not Lewisham, not King’s—is currently meeting the 95% targets for seeing attendances at A and E, so that is not surprising. The e-mail went on to say,

“and routine operations…the trust is predicting a deficit of more than £40m this financial year. This deterioration in its operational and financial performance follows the unexpected costs of making urgent improvements to the quality of care at the PRUH.”

Well, Princess Royal was taken over by King’s College hospital as a consequence of the trust special administrator’s recommendations, and that is the problem it has run into.

When the trust special administrator was appointed, the Secretary of State said in a statement to the House:

“The trust is losing well over £1 million of taxpayers’ money a week, which means that vital resources are being diverted from other parts of the NHS.”—[Official Report, 29 October 2012; Vol. 552, c. 3WS.]

The difference between the £1 million a week then and the predicted £40 million a year at PRUH alone now clearly demonstrates that the trust’s special administration process did not address the right problems. Clearly, the problem was predominantly at Princess Royal.

Queen Elizabeth is now part of a very successful partnership with University hospital Lewisham, and it is doing quite well. It is not without difficulties, but that is the case for any organisations that come together under difficult circumstances. However, it is making progress in clinical and financial affairs, and is well on the way to building a solid and reliable NHS entity in our part of south-east London. That demonstrates that the entire TSA process was substantially illegal, because as we know, the High Court—and subsequently the Court of Appeal—found the trust special administrator’s recommendation with regard to Lewisham hospital, and the current Secretary of State’s stubborn refusal to accept anything other than those proposals, to be illegal. The Secretary of State did not have the powers he assumed he had and could not reorganise in the way that was suggested. He even had the hubris to try and test it at the Court of Appeal, which found similarly that that was the case. Thankfully, sense prevailed at that stage and he left it there, deciding not to waste any more taxpayers’ money by going to the Supreme Court.

However, the Government introduced an amendment to the Bill that became the Care Act 2014, giving them the power that they thought they originally had to do whatever they liked by appointing a trust special administrator. This is where we come to the key worry about the future of Princess Royal and King’s. It is not just about the services that are provided there, which are critically important to all the constituents of Members here today, but about the fear that Monitor, using the powers that the Government put into that Act, will try to engineer another back-door reorganisation involving Lewisham hospital. As I say, that was originally declared illegal, but Lewisham could be dragged into it by other means, so the Government can achieve what they originally meant to achieve and were stopped from so doing.

[Robert Neill (Bromley and Chislehurst) (Con)]

I understand the hon. Gentleman’s point. Do I gather that his principal concern is the impact on Lewisham, and not the fact that Monitor is looking at accepted issues at the Princess Royal and King’s? From his point of view, it is the Lewisham dimension, rather than what it is necessary to do at the Princess Royal. Am I right in that?

[Jim Dowd]

I broadly agree with the hon. Gentleman’s point. Clearly, financial management is an important part of running the NHS. Everybody knows that, whether it is in our part of south-east London or more broadly.

[Bob Stewart (Beckenham) (Con)]

I totally agree with everything that the hon. Gentleman has said. My worry is that the Secretary of State negated the bill. It was wiped clean, and £44 million is a huge amount of money in the very short time that King’s has apparently been mismanaging the PRUH.

[Jim Dowd]

I understand the hon. Gentleman’s point. I do not think that would be King’s view. I hold no particular brief for King’s college hospital, other than the fact that I had a heart bypass there a few years ago, so I owe them my life. However, beyond that, I have no particular indebtedness to them. I know that there is a strong feeling that it was misled about what taking on the PRUH would actually mean, and the operational and financial consequences.

[Bob Stewart]

I accept that point.

[Jim Dowd]

That is very gracious—characteristically so—of the hon. Gentleman. I have four points to make briefly: three are questions, and I would also like an assurance from the Minister.

First, I would like an indication about the time scale. How long will Monitor take to report and what is the process following the report? Who will get to review it and how will it be taken beyond that? Secondly, what are the requirements/benefits and the consequences of what Monitor and the letter I received from King’s later that day—5 March—say, which is that the legal powers that Monitor possesses are needed to underpin the changes that are necessary to King’s foundation trust and the PRUH? Thirdly, how much consultation will there be with other providers and commissioners across south-east London outside King’s College Hospital NHS Foundation Trust? Finally, I want an absolute guarantee that University hospital Lewisham and Queen Elizabeth hospital Woolwich, now the Lewisham and Greenwich trust, will not be adversely affected by any decisions that Monitor makes.

--- Later in debate ---

[Jane Ellison]

If it is acceptable to the hon. Lady, I will write to her to provide some clarity on that. It might be helpful, for example, for Monitor to give examples from other investigations of the sorts of things that it undertook and the changes that it requested through the formal process. I will write to her with some examples to give her a sense of that. I have sought to give a degree of reassurance to Members, and I hope that I have managed to do so.

[Jim Dowd]

I detect that the Minister has almost concluded her remarks, and I will not have the opportunity to intervene once she has sat down. I am grateful for what she has said, and I will look at the Official Report most carefully. I would be grateful to be copied in on any information that is sent to other Members.

I would like to make another point, out of courtesy, as much as anything else. The hon. Member for Bromley and Chislehurst welcomed the appointment of the new chair of King’s trust, Lord Kerslake. May I put on record a huge vote of gratitude to Sir George Alberti, who is standing down as the chair of the trust, for the service that he has given to King’s and the health service more generally?

[Jane Ellison]

That is entirely appropriate. I detect a desire among Members from all parts of the Chamber to work towards a better future for the health economy in their local areas. At the end of the process, we want sustainable, excellent services that offer the quality of care that we would wish for our constituents. Although there is not much time left in this Parliament, I undertake to look at the Hansard record of the questions asked by both hon. Members, because the topic is so important for their constituencies. If there is anything I can add to my remarks by way of clarity or response, I will get that to them. Monitor has heard me put on the record my desire for Members of Parliament to be kept fully involved and engaged with the process once we are through the small matter of the general election.

I believe that this is the last Westminster Hall sitting of this Parliament. In the minute that remains, I would like, on behalf of hon. Members who are present and the many hundreds of others who have spoken in and attended our second debating Chamber over the course of the Parliament, to thank you, Mr Betts, and, through you, all your colleagues who have chaired our debates. I thank all the staff of the House, the Doorkeepers and all who have attended and participated in those debates. I have apparently clocked up 50 debates while I have been a Health Minister, many of them in Westminster Hall. It is apparent to me that Westminster Hall serves an important purpose in allowing us to debate important matters, particularly those of the nature of the subject that we have discussed today. On behalf of all Members of Parliament, I thank all the staff and everyone who supports Westminster Hall in its duties.

Care Bill [Lords]

Jim Dowd Excerpts

Tuesday 11th March 2014 Commons Chamber

[Dr Poulter]

rose—

[Jim Dowd (Lewisham West and Penge) (Lab)]

rose—

[Andy Burnham]

I give way to my hon. Friend.

[Jim Dowd]

My right hon. Friend says that clause 119 is the result of defeat in the courts. That is true. However, the Government capitulated before the decision of the appeal court was known, just after the decision of the High Court in July. My contention—if I am able to catch your eye later, Madam Deputy Speaker, I would be happy to elaborate further—is that the Government knew from the outset that they had no legal power to do it and were just, in the way of all bullies, trying it on until somebody stopped them.

--- Later in debate ---

[Sir Tony Baldry]

I do find that reassuring, but I have a final question that I hope my hon. Friend will address when he winds up the debate. There has to be a trigger, but what will the trigger be for these extreme circumstances? In other words, what distinguishes a proposal for hospital reconfiguration, in which local people can go to the health overview and scrutiny committee and the Independent Reconfiguration Panel, from a crisis situation, such as occurred in Mid Staffordshire and may have occurred in Lewisham? We all have local hospitals and we all need to be able to explain to our constituents how we might find ourselves in the circumstances of these short-cut situations. We really need Ministers to make it clear to the House that these powers will be used in extremis, and I hope that my hon. Friend will address that point when he winds up.

[Jim Dowd]

I agree strongly with the sentiment expressed by the hon. Member for Stafford (Jeremy Lefroy) that no community should be subjected to the tender mercies of the trust special administrator regime. It is brutal, harsh, unfair, unreasonable and impervious to local knowledge or opinion.

Following the way in which most reports are presented, I shall start with my executive summary—my understanding of what happened in the South London Healthcare NHS Trust. The right hon. Member for Banbury (Sir Tony Baldry) was wrong. The special administrator was not appointed to Lewisham hospital. That is the very heart of the matter. He was appointed to the South London Healthcare NHS Trust, which is the adjoining trust, then comprising the Queen Elizabeth hospital in Woolwich, the Princess Royal university hospital in Orpington and Queen Mary’s hospital in Sidcup. He then decided to take a well-functioning, well-respected, well-performing and financially sound institution, in the shape of Lewisham hospital, and use it to deal with problems elsewhere.

In an Adjournment debate 18 months ago when the issue first occurred, I used the simile that it was like the administrator for Comet advising that the best thing to do, in the interests of Comet, was to close down Currys. That is exactly what the trust special administrator did.

[David T. C. Davies (Monmouth) (Con)]

If the hon. Gentleman believes that it is important that local people are listened to, would he care to comment on the decision by Labour’s Health Minister in Wales, Mark Drakeford, to shut down or downgrade Withybush hospital in west Wales?

[Jim Dowd]

The short answer is no, I do not wish to comment.

Lewisham was stitched up from day one. In 40 years as a public representative I have rarely come across anything so disreputable, so devious, so mendacious, so dishonest and so duplicitous as the process that was employed regarding south London health care. It started on 13 January 2012 when the then Secretary of State, the right hon. Member for South Cambridgeshire (Mr Lansley), now Leader of the House, laid an order before the House entitled the South London Healthcare National Health Service Trust (Appointment of Trust Special Administrator) Order 2012, alongside an explanatory memorandum that included the case for applying the regime for unsustainable NHS providers—the first time it had been done. There was also an additional order that extended the consultation period for the trust special administrator. As I say, it was called the South London Healthcare National Health Service Trust. When the administrator got on with his work and produced a report, it was entitled, “The Trust Special Administrator’s Report on South London Healthcare NHS trust and the NHS in South East London”. Parliament did not authorise an inquiry into the NHS in south-east London, but, by that cover, they attempted to shut down a perfectly well-functioning district general hospital in Lewisham because it was administratively more convenient.

On 16 July, Mr Matthew Kershaw was appointed as the trust administrator. I had numerous dealings with Mr Kershaw. Personally, I found him to be a perfectly reasonably, sane and sensible person, but he was commissioned by the Department to do a job. His priority, quite plainly and self-evidently, was not to decide what was in the best interests of the people of south-east London, but to do the bidding of Richmond House.

[Richard Drax (South Dorset) (Con)]

May I just clarify my concern that administrators can reach out, far beyond where we initially thought they could, into such areas as community hospitals, of which there are several in my constituency? The NHS is in such a financial mess, and getting worse, that these powers will inevitably provide a temptation to interfere more, and the Secretary of State will be able to close hospitals against the will of local people.

[Jim Dowd]

I accept absolutely the hon. Gentleman’s point. The wording of the clause is such that the powers are virtually unfettered—they are untrammelled. It does not say that an administrator can make recommendations about neighbouring trusts or nearby trusts; it says that they can make a recommendation about any trust anywhere in the entire health economy. It will be a threat to every single Members’ community willy-nilly, because it will be the new norm.

I will come on to what Lewisham experienced previously, but there used to be clinically led reconfiguration panels. This Government seem to have eschewed them. They are difficult and complicated, but they need to be so because this is a premier public service that matters so much to people in every part of this country. They are eschewing that in favour of an administrative route that will give them untrammelled powers.

[Bob Stewart (Beckenham) (Con)]

rose—

[Jim Dowd]

I give way to the gallant hon. Gentleman.

[Bob Stewart]

I thank the equally gallant hon. Gentleman and a neighbouring Member of Parliament. I, too, have never understood why Lewisham hospital had to be involved in this exercise, and I still fail to see why it has to suffer as a consequence of the failure of other hospitals that, although they are outside my constituency, affect my constituents deeply.

[Jim Dowd]

The hon. Gentleman is right. We have discussed the impact of this on our constituents many times.

I will try to shed some light on why Lewisham was put in the firing line, and why such administrative vehicles are so dangerous and antithetical to good health care. On 24 July 2012, the then Secretary of State invited the Members for Bexley, Bromley and Greenwich to a meeting in his office. That is entirely logical, because South London Healthcare Trust covers Bexley, Bromley and Greenwich. Strangely, he also invited the Members for Lewisham. My right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) was unfortunately unable to attend, but my hon. Friend the Member for Lewisham East (Heidi Alexander) and I did attend.

--- Later in debate ---

[Dame Joan Ruddock]

I want to ensure that my hon. Friend does not end this part of his speech without reminding the House that one of the things that those involved in the TSA process intended to do was sell off half the land occupied by the buildings of Lewisham hospital—and that was not in the public consultation document.

[Jim Dowd]

It is with some trepidation that I must disagree with my right hon. Friend. In fact, the figure was closer to two thirds of the estate. The scheme was so well engineered that they left the bit that we were keeping, allegedly, for whatever was going to be there—a glorified first aid post—completely landlocked. There was no access apart from via the River Ravensbourne, which is not the mode of transport favoured by most people using Lewisham hospital. Oh yes, it was all worked out well beforehand.

The public meetings following the publication of the draft report were, of course, rather more difficult to control. People were able to ask questions, although they did not receive many answers. Those who were presenting the case on behalf of the trust special administrator did not seem particularly receptive to what was being said, although on occasion, when they came up against a difficult objection, they would say “South London Healthcare NHS Trust is losing £1 million a week: £1 million that is not being spent on health care for patients.” We know that—it is self-evident—but when they were told “That is not the problem of Lewisham hospital”, and asked “Can you not understand that?” , the answer was no, they could not understand it.

That was followed by a little homily of the kind much beloved of some people: “If your domestic budget was being overspent week after week, you would need to take action, would you not?” Naturally everyone agreed, but a woman who attended the public meeting at Sydenham school said to Mr Kershaw, “If your domestic budget was being overspent, of course you would have to do something about it, but that would not include breaking into the house of the people next door and nicking all their stuff”—which is what was being proposed in south London by the special administrator.

After attending numerous meetings with Mr Kershaw and his associates, and at the other south London hospitals, I eventually concluded that—recognising that those who would be worst affected by their proposals were hardly likely to be very receptive to them—they automatically assumed that there would be opposition and hostility, and automatically factored in and discounted it, saying “Of course they are going to object to the changes, but we have a task and a mission to pursue.” The whole process was condescending, impenetrable and antagonistic. The special administrator and his acolytes and accomplices had a mission, given to them before they ever left Richmond House, which they were determined to deliver. They already knew the answer, and they were not going to bother to do anything other than go through the motions.

We owe thanks to Lewisham council, to the Save Lewisham Hospital campaign and, amazingly enough, to the High Court and the Appeal Court, whose three judges—Lords Justices Dyson, Underhill and Sullivan—within 24 hours unanimously overturned the Secretary of State’s case that he had the powers to do this. As I have said, the Secretary of State had already capitulated by then. The Government knew from the outset that this was legally questionable. They knew they did not have the powers to behave in the way they were behaving, but they basically just said, “Who’s going to stop us?” I will tell you who stopped them: the people of Lewisham and their supporters and the High Court. That is who stopped them.

This clause will make occurrences like that more, not less, likely. More communities across the country are going to be threatened and will come under the tender mercies of the TSA process.

[Andy Burnham]

My hon. Friend is absolutely right. More communities could face this threat, but is not the point that those communities would not have the ability to fight it in the way that Lewisham was able to fight and defeat it?

[Jim Dowd]

My right hon. Friend is right; that is precisely the point and that is precisely what this Government intend. I have absolutely no doubt about that; their writ will run whether people want it or not.

After all that, what is the current position of South London Healthcare NHS Trust—after that £5 million? Princess Royal in Orpington is now an adjunct of King’s College hospital. The TSA was quite happy to say the whole thing should be passed lock, stock and barrel to King’s. There was a rather unseemly squabble about the size of the bung King’s should get for taking on Princess Royal, but there was no specification about the services that should be provided there or anywhere else; that was entirely up to King’s. Queen Mary’s, which of course is not a fully functioning district general hospital, is now being managed by Oxleas NHS Foundation Trust, the primary care trust in that part of the world. Again, the TSA made no recommendations about what services, or what range of services, should be provided there.

Queen Elizabeth, which, of course, is the biggest problem in what was South London Healthcare NHS Trust, has now merged with Lewisham university hospital in the Lewisham and Greenwich NHS Trust. It is now managing a very difficult proposition; I do not dispute that for a moment. I have my doubts about whether that is the best move for the people of Lewisham, but I understand why it has been done. Yet, the board at university hospital Lewisham was prepared to enter into that agreement before the TSA even set foot in the area. So what we have now in south-east London was entirely possible by rational argument and reasoned consent without the need for the TSA and all the disruption, anguish and distress he and his acolytes have caused. I say to Members voting on this tonight, “Remember; you may not want to visit a TSA and I don’t blame you, but that won’t prevent them from visiting you if this clause goes through.”

[Paul Burstow]

I start by acknowledging the receipt of a petition handed to me yesterday, containing 159,000 signatures collected by members of 38 Degrees, expressing their concerns about the matter we are debating today. I know that a great many Members will have received e-mails about that and will have their own opinions, and I want to discuss the issues.

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[Jim Dowd]

Will the right hon. Gentleman give way?

[Mr Burns]

No. I am about to conclude as I know the winding-up speeches have to begin.

In conclusion, this is an important power, and it is there to be used in very exceptional circumstances. It is factually incorrect and it will scare people to accuse any Government of using the power to reconfigure services. It will not be used for that. Reconfiguration will go through the correct processes and be based locally, with the local health economy and local people and with the input of organisations such as the health and wellbeing board. It would be foolish, as I think the previous Government agreed, not to have an emergency fall-back position to secure that. That is why we had the original power under Labour’s legislation, and my right hon. Friend the Secretary of State is continuing that power and fine-tuning it.

--- Later in debate ---

[Dr Poulter]

My hon. Friend makes a good point, which has been made by Government Members throughout this debate. Under the previous Government, in particular, many people felt that things were done to them with their local NHS, rather than done in the best interests of local patients. Importantly, decisions were very rarely made with clinical leadership under the previous Government. Proper patient consultation and patient engagement did not take place. I have a list with me of maternity units downgraded under Labour; it is right to say that individual reconfiguration decisions need to be looked at on their merits, but there was a long and tragic history under the previous Government of the public, patients and local clinicians not being properly engaged in the process. That is why our Government have introduced a better process whereby, as my right hon. Friend the Member for Chelmsford (Mr Burns) pointed out, decisions about local health care services under our 2012 Act are led now by clinicians through the clinical commissioning groups. We now have health and wellbeing boards, which is an important step forward in better joining up and integrating the health and care system that we all believe in, and in ensuring that democratically elected local authorities have more oversight of our health and care system. Those are important steps forward and this Government should be proud of them. They indicate that decisions should be made locally for the benefit of local people, and that is how things routinely happen.

The trust special administrator regime is not used lightly; it is used in extremis, which is why it has been used only twice in the past five years.

[Jim Dowd]

rose—

[Dr Poulter]

Let me make a little progress, because I have been generous in giving way.

Let us consider the following:

“The vast majority of trusts perform well, but in the rare instances where that is not the case, there must be transparent processes in place to deal with poor performance.”—[Official Report, 8 June 2009; Vol. 493, c. 544.]

I completely agree with those words—the right hon. Member for Leigh (Andy Burnham) used them when he described the purpose of the regime to this House in 2009. This is Labour’s regime, which it now tries to disown in opposition. The TSA regime is only ever used as the very last resort, and provisions in the Care Bill will introduce, importantly, a new role for the Care Quality Commission for triggering the regime when there has been a serious failure of quality; the emphasis will now be on quality, rather than merely on financial failure.

Clause 119 respects the coalition agreement that routine service changes will be locally led; it is about protecting patients and ensuring we can act rapidly and effectively in their best interests in examples of extreme failure. It may therefore be helpful if I set out some of the changes and improvements we are making to the regime under clause 119.

--- Later in debate ---

[Jim Dowd]

Will the Minister give way?

[Dr Poulter]

I do need to make some progress, as I have been generous in giving way. If hon. Members will let me make some progress, I may give way again a little later.

Clause 119 was introduced following calls to the Government by key stakeholders representing NHS providers—the Foundation Trust Network and the NHS Confederation. Like us, they recognise the experience of how the regime has operated. They know that issues of financial and clinical sustainability of health services nearly always cross organisational boundaries, and they were clear that the Labour Government’s regime needed amendments to make it effective in the spirit that the right hon. Member for Leigh intended when he created it in 2009. Let me read out again what was said in the impact assessment to the 2009 TSA regime—his regime. It states:

“NHS Trusts…are not free-floating, commercial organisations.”

It also says:

“State-owned providers are part of a wider NHS system.”

We fully agree with that, and that is what we are ensuring we take into account in the TSA regime. That is what clause 119 is about. Clause 119 would extend the remit of a TSA to make recommendations that may apply to—

[Jim Dowd]

rose—

[Andy Burnham]

rose—

--- Later in debate ---

[Dr Poulter]

I have repeatedly read out supporting evidence from the previous Government and from the impact assessment that showed that they recognised that the regime had to take into account the wider health economy. It is not my fault or the fault of hon. Members on the Government Benches that Labour’s legislation was not properly drafted, and that it did not do what it intended—

[Jim Dowd]

Will the Minister give way?

[Dr Poulter]

The right hon. Gentleman also suggested—

[Jim Dowd]

Is he deaf?

[Madam Deputy Speaker]

Order. The Minister’s state of health is not a matter to be dealt with from a sedentary position. If he is not giving way, he is not giving way.

--- Later in debate ---

[Mr Hunt]

I thank my hon. Friend for her work in Committee. That is an aspiration that we all share, and some of the results from the pilots are extremely encouraging in terms of the extra care and support we are able to give people. End-of-life care is a priority for everyone, so I share her enthusiasm that we can make progress on that very important area.

Financial security must be combined with confidence in the standard of care received. A year on from the Francis report, we are debating a Bill that will help us to deliver 61 commitments that we made in response to it. We are restoring and strengthening a culture of compassionate care in our health and care system.

Robert Francis’s report said that the public should always be confident that health care assistants have had the training they need to provide safe care. The Bill will allow us to appoint bodies to set the standards for the training of health care assistants and social care support workers. These will be the foundation of the new care certificate, which will provide clear evidence to patients that the person in front of them has the skills, knowledge and behaviours to provide compassionate high-quality care and support.

New fundamental standards will ensure that all patients get the care experience for which the NHS, at its best, is known. In his report, Robert Francis identified a lack of openness extending from the wards of Mid Staffs to the corridors of Whitehall. We want to ensure that patients are given the truth when things go wrong, so the Bill introduces a requirement for a statutory duty of candour which applies to all providers of care registered with the CQC. The Francis inquiry also found that providing false or misleading information allows poor and dangerous care to continue. We want to ensure that organisations are honest in the information they supply under legal obligation, so the Bill introduces a new criminal offence for care providers that supply or publish certain types of false or misleading information.

The care.data programme will alert the NHS to where standards drop and enable it to take prompt action. To succeed, it is vital that the programme gives patients confidence in the way their data are used. For that reason we have today amended the Bill to provide rock-solid assurance that confidential patient information will not be sold for commercial insurance purposes.

Patients also need to have confidence that where there are failings in care they will be dealt with swiftly. At Mid Staffs that took far too long. That is why the Care Bill requires the CQC to appoint three chief inspectors to act as the nation’s whistleblowers-in-chief. Their existence has started to drive up standards even in the short time they have been in their jobs.

Perhaps most fundamentally, the Bill re-establishes the CQC as an independent inspectorate, free from political interference. The Bill will remove nine powers of the Secretary of State to intervene in the CQC to ensure that it can operate without fear or favour. The Bill will also give the CQC the power to instigate a new failure regime and will give Monitor greater powers to intervene in those hospitals that are found to be failing to deliver safe and compassionate care to their patients. For the most seriously challenged NHS providers, there needs to be a clear end point when such interventions have not worked. The Bill makes vital changes to the trust special administration regime, established by the Labour party in 2009, to ensure that an administrator is able to look beyond the boundaries of the trust in administration to find a solution that delivers the best overall outcome for the local population.

[Jim Dowd]

I realise that the Secretary of State was not in office when the TSA process was started in the South London Healthcare NHS Trust, but he did accept the report of the administrator and, of course, appealed against the High Court decision that found against him. Will he clarify and put on the record that it is the coalition Government’s view, and the view of their constituent parties, that the people of Lewisham should not have an accident and emergency unit; should not have a maternity unit; should not have a paediatric specialty; and that two thirds of the hospital site should be sold off? Those were the recommendations of the TSA, which he wanted to accept.

[Mr Hunt]

Let me first tell the hon. Gentleman that the TSA did not recommend the closure of the A and E unit at Lewisham hospital, and he knows that perfectly well.

I will say what this Government are determined to ensure does not happen again. Mid Staffs went on for four years before a stop was put to it. Patients’ lives were put at risk and patients died because the problem was not tackled quickly. The point of these changes today is to ensure that, when all NHS resources are devoted to trying to solve a problem and they fail, after a limited period of time it will be possible to take the measures necessary to ensure that patients are safe. I put it to the hon. Gentleman and to all Opposition Members that if they were in power now they would not be making the arguments that they have been making this afternoon, because it is patently ridiculous to say that we will always be able to solve a problem without reference to the wider health economy. They know that: it was in the guidance that they produced for Parliament when they introduced the original TSA recommendations. What Government Members stand for is sorting out these problems quickly and not letting them drag on in a way that is dangerous for patients.

Changes to Health Services in London

Jim Dowd Excerpts

Wednesday 30th October 2013 Commons Chamber

[Mr Hunt]

I commend my hon. Friend for raising this issue with me consistently. I know his very real concern is to make sure that when those changes are made they do not have an adverse impact on his constituents. I will go back and make absolutely certain that no changes will be made until it is certain that they are clinically safe.

[Jim Dowd (Lewisham West and Penge) (Lab)]

Why does the Secretary of State find it so difficult to realise that he is not above the law? Both the Court of Appeal and the High Court have made it plain that his flagrant disregard for the law in trying to destroy Lewisham hospital cannot stand. Why does he not have the decency to abandon his proposals; apologise to the people of Lewisham and the staff and users of Lewisham hospital; and share his humiliation with the Leader of the House, the previous Secretary of State, who launched this illegal programme in the first place?

[Mr Hunt]

There is no humiliation in doing the right thing for patients, and I will always do that. Sometimes it is difficult and we have battles with the courts, but no one is above the law. I have said that I respect the judgment made by the court yesterday, and that is what I shall do.

Health and Social Care

Jim Dowd Excerpts

Monday 13th May 2013 Commons Chamber

[Mr Hunt]

Because that is what the independent medical advice I have received has told me. The right hon. Lady should be very careful about the Newark statistics, because the increase in mortality rates, which is worrying and should not happen, happened before the A and E was downgraded. It is very important that we do not get the figures wrong.

[Jim Dowd (Lewisham West and Penge) (Lab)]

Will the Secretary of State give way?

[Mr Hunt]

I am going to make some progress.

Before I took the right hon. Lady’s intervention, I was talking about joined-up care. The truth is that Labour’s disastrous IT contract wasted billions and failed to deliver the single digital medical record that would transform the treatment received by so many vulnerable older people. Yes, it was a financial scandal, but it was also a care scandal. Last year, 42 people died because they received the wrong medicines. There were more than 20,000 medication errors that caused harm to patients, and 127,000 near misses. On top of that, structures such as payment by results were left unreformed for more than 13 years, making hospitals focus on the volume of treatment over and above the needs of individual patients. The Care Bill will help to address those issues by promoting integrated care. It creates a duty on local authorities and their partners to co-operate on the planning and delivery of care; it emphasises the importance of prevention and the reduction of people’s care needs; and, by making personal budgets the default and not the exception, it will significantly increase the control people feel over their care.

[Mr Hunt]

It is the right hon. Gentleman who has a problem with the difference between rhetoric and reality. Let me tell him about the reality of what happened to integrated care under Labour. Between 2001—[Interruption.] The right hon. Gentleman intervened, so perhaps he would like to hear the reply. We are talking about integrated care. On his watch, between 2001 and 2009—eight years during which Labour was in power—hospital admissions went up by 36%. In Sweden, where people started thinking about integrated care, such admissions went up by 1%. That is how badly Labour failed to do anything about integrated care when it had the chance. We are doing something about it. If the Opposition listen, I shall explain what.

[Jim Dowd]

Will the Secretary of State give way?

[Mr Hunt]

I am going to make some progress.

The third question that the Care Bill addresses is about sustainable funding for care. We are all going to have to pay more for social care costs, either for ourselves or our families. Tragically, every year, up to 40,000 people have to sell the homes that they have worked so hard for all their lives to fund their care.

Our system does not just fail to help those who need it; it actively discourages people from saving to ensure that they have the funds. In 1997, Labour promised a royal commission on long-term care. The commission reported in 1999, and its recommendations were ignored. We then waited 10 whole years for a Green Paper, which arrived in 2009 and, again, was able to deliver nothing.

In stark contrast, in just three years, the coalition Government commissioned a report from Andrew Dilnot, have accepted it and are now legislating for it. The Care Bill will introduce a cap on the costs that people have to pay for care in their lifetimes. With a finite maximum cost, people will now be able to plan through their pension plan or an insurance policy. With a much higher asset threshold for state support, many more people will get help in paying for their care.

Accountability and Transparency in the NHS

Jim Dowd Excerpts

Thursday 14th March 2013 Commons Chamber

[Jim Dowd (Lewisham West and Penge) (Lab)]

It is a pleasure to follow the hon. Member for Southport (John Pugh), who always makes thoughtful contributions.

I congratulate those Members who tabled this motion, to which I was happy to add my name. I am grateful to the Backbench Business Committee for agreeing to this debate, but, like others, I feel that the issue is so important that it should be debated in Government time. However, I suspect that, in the light of developments, we have not heard the last of the issues raised by the Francis report. The Secretary of State outlined a few of the measures he is intending to bring before the House, so we will have opportunities for other such debates.

I will not refer in any great detail to the Mid Staffs fiasco, serious though that is, and the obvious implications for other areas across the country. I want to concentrate on transparency, and to avail the House of the experience in south-east London of the tender mercies of the first, and so far only, trust special administrator, who was appointed to the trust next door to Lewisham—the South London Healthcare NHS Trust. That trust comprises the Princess Royal University hospital, in Orpington; the Queen Elizabeth hospital, in Greenwich; Queen Mary’s hospital, in Sidcup; and the Orpington hospital—although that was actually subject to a separate consultation.

The then Secretary of State said in a statement on 12 July last year:

“I wish to inform the House that I have made an order to appoint a trust special administrator to South London Healthcare NHS Trust…The regime, included by the last Government in the Health Act 2009, offers a time-limited and transparent framework to provide a rapid resolution to the problems within a significantly challenged NHS trust”—

trust, singular. He continued:

“The trust special administrator’s regime is not a day-to-day performance management tool for the NHS or a back-door approach to reconfiguration.”—[Official Report, 12 July 2012; Vol. 548, c. 47-48 WS.]

On 13 July, he issued the order to give effect to those measures.

I raise this as a transparency issue because the trust special administrator brought forward proposals that damage, downgrade, devastate, destroy—whichever word one wants to use—Lewisham hospital, which is a completely separate trust. The right hon. Member for Charnwood (Mr Dorrell), who is the Chair of the Health Committee and has great knowledge and experience of these matters, said that accountability and transparency are interlinked: we cannot have one without the other. I agree with him wholeheartedly, but that has not been the experience of the people in Lewisham: the TSA is entirely unaccountable. The TSA stands at the head of a disgraceful, disreputable conspiracy—launched in the Department of Health, aided and abetted by NHS London and handled in the most autocratic manner—to downgrade Lewisham hospital.

The titles of both the orders issued by the Secretary of State, copies of which I have here, start with the words:

“The South London Healthcare National Health Service Trust”.

The order setting up the administrator states:

“That draft report to the Secretary of State must state the action which the trust special administrator recommends the Secretary of State should take in relation to the South London Healthcare National Health Service Trust.”

It contains no mention of anybody else, yet the Department now says, “Of course we needed to look at the whole of south London and the whole of the health economy of south-east London, because everything connects to everything else.” Well, that is true of everything in the whole wide world.

From day one, all the documents of the TSA included the phrase “Securing sustainable NHS services”. One such document was headed: “Securing sustainable NHS services—Consultation on the Trust Special Administrator’s draft report for South London Healthcare NHS Trust and the NHS in south east London”. This House did not give the administrator that authority—the law does not provide for the administrator to look at the situation across south-east London—and he has acted beyond his powers.

I come now to the most interesting thing, and I accept that the current Secretary of State has had this matter dropped in his lap. If this was always about the whole of south-east London, why when the former Secretary of State had a meeting in July to discuss this did he invite the Members who represented Bromley, Bexley and Greenwich—rightly, because they cover the South London Healthcare NHS Trust area—and the Members for Lewisham? One could say that it was because they were looking more widely. Of course that is so, but he did not invite the Members representing Lambeth or Southwark. However, when we met this Secretary of State in January, after the TSA’s final report had been published, the Members for Lambeth and Southwark were included; we were told that this was a south London-wide issue. The reason for the discrepancy is obvious: they knew what they wanted to do. They wanted to get an old plan that NHS London had fostered to try to get Lewisham hospital closed. That took place under a proper clinical review under “A picture of health” four years ago, which concluded that Lewisham hospital deserved to survive and that the services it provided for the people of Lewisham should continue.

Some 10,000 people marched in November to oppose the proposals. When the final report came out, 25,000 people marched because of the outrageous actions of this administrator and the activities he has undertaken. The manner in which he dealt with the consultations was dismissive, disdainful and high-handed. Whether the objections were from members of the public, GPs or other clinicians, he behaved in line with the instructions from his bosses, which were simply to close Lewisham hospital. The people of Lewisham will not stand for it.

Accident and Emergency Departments

Jim Dowd Excerpts

Thursday 7th February 2013 Commons Chamber

[Stephen Lloyd]

I thank my hon. Friend for her intervention. That is a very important point and I shall be covering it in more detail later in my speech.

Last October, a group of 140 senior doctors wrote to the Prime Minister expressing alarm over proposals to close and reconfigure A and E units around the country. In their open letter, they said that they had yet to see evidence that plans to centralise and downgrade A and E services were beneficial to patients. A 2010 report by the National Confidential Enquiry into Patient Outcome and Death showed that the reason people often die after surgery is not that the surgery was difficult but that there was a delay in getting them to an emergency operation. I fear that that will be worse if more A and Es are closed as there will be no surgeon on site, or the patient will face an over-long travel time to a fully functioning and adequately staffed emergency department. The report was clear, suggesting that applying one-size-fits-all medicine to a heterogeneous population with varying needs fell short in ways that were both predictable and preventable. Crucially, it stated:

“Delays in surgery for the elderly are associated with poor outcomes”.

The letter to the Prime Minister also backed this view:

“Not only do many people in some of the country’s most deprived areas face longer journeys to hospital, but those in rural areas face longer waiting times for ambulances and crowded A and E departments when they arrive.”

Let me point out the obvious: that will mean more delay for what should be routine emergency surgery.

That is in contrast to how I foresaw developments in May 2010 when the coalition Government came to power. Unlike Labour, the coalition ring-fenced NHS funding.

[Jim Dowd (Lewisham West and Penge) (Lab)]

How can sums be ring-fenced if at the same time the Department insists on a 1% surplus—that is, money that cannot be spent?

[Stephen Lloyd]

The key difference is that the coalition Government ring-fenced it whereas the Opposition were considering a 20% cut—that is quite substantial.

Four reconfiguration tests were designed to build confidence among patients and communities as well as within the NHS. The right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) has already listed them, so I do not need to repeat them. In Eastbourne, my local hospital is run by East Sussex Healthcare NHS Trust, which also manages the Conquest hospital in Hastings. Last year, it consulted on the provision of orthopaedics, general surgery and stroke care in East Sussex. In my view and that of the cross-party Save the DGH campaign group, led by our remarkable and hard-working chair Liz Walke, it was clear from early on that the trust’s aim was to remove core services from my local hospital, the Eastbourne district general hospital, irrespective of the consultation.

This was not the first time the trust had tried to remove core services from Eastbourne. Only five years earlier it had tried, unsuccessfully, to downgrade our maternity services. At the time the trust claimed that that would provide safer and more sustainable services for the people of East Sussex. However, after much local opposition the independent reconfiguration panel found against the trust’s proposals, so when my local hospital trust again consulted on health services in East Sussex, my constituents and I were very worried. I was uneasy, as so many local clinicians started to share with me confidentially their deep concerns about the trust’s proposals.

I reassured constituents that we were in a stronger position than last time because the coalition Government had shown their commitment to the NHS by ring-fencing the NHS budget at a time of deep financial constraint. In addition, the Prime Minister and the then Health Secretary, the current Leader of the House, had continually stated that the NHS would be led by the public and clinicians, and to ensure this they had introduced the four reconfiguration tests that were mentioned earlier.

Imagine my horror when, just before Christmas, my NHS hospital trust had its proposals confirmed by the East Sussex health and overview scrutiny committee and was given the go-ahead for its plan to remove emergency orthopaedics and emergency and highest-risk elective general surgery from Eastbourne district general hospital and site them only at the Conquest hospital in Hastings, as much as 24 miles from some of my constituents.

The consultants advisory committee, the body which represents consultants at Eastbourne DGH, conducted a confidential survey of its members’ views on the trust proposals. More than 90% of DGH consultants responded to the survey, with 97% of those respondents opposed to the proposals. I remind colleagues in the House of the four tests. A confidential GP survey was also conducted and 42 GPs in the town also opposed the trust’s plans. In addition, 36,766 local people signed a petition against the proposals.

--- Later in debate ---

[Jim Dowd (Lewisham West and Penge) (Lab)]

I am pleased to follow the hon. Member for Eastbourne (Stephen Lloyd). I thank him, the hon. Member for Newark (Patrick Mercer) and my hon. Friend the Member for Ealing, Southall (Mr Sharma) for securing this debate and the Backbench Business Committee for agreeing to their representations.

I will return in a moment to a few things that the hon. Member for Eastbourne said, because he got to the thrust and the kernel of a lot of the problems with the four tests, although his attitude towards them is a good deal more generous than mine.

[Mr Love]

The four tests were invented for the reconfiguration of Chase Farm hospital, which predates everything that we are discussing today. If we look back at what happened there, it is clear that it did not matter what local opinion was, what local medical opinion was, or that everyone at Chase Farm was opposed—there was a determination to go ahead regardless. So the whole thing becomes a farce and a complete sham, and the four tests do not really add up to anything in terms of protecting local services.

[Jim Dowd]

My hon. Friend has it exactly. That is precisely our experience in Lewisham, which I will elaborate on in a few moments, where we have seen that the four tests are a fig leaf and entirely inconsequential, and, more than anything else, that the Secretary of State can blithely announce that he has decided that they have been met and that that is all that counts. There is no review, no appeal, no objective analysis, no consideration of alternative views: it is just a case of the Secretary of State saying yes. It is precisely as Humpty Dumpty said: “Words mean exactly what I choose them to mean, and that is it.” That is the position of the Secretary of State.

My right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) went over a lot of the ground that is concerning us in Lewisham regarding the outrageous proposals by the trust special administrator appointed in South London Healthcare NHS Trust. Let me emphasise that the reason for the anger, the outrage, the fury and the sense of seething injustice in Lewisham is not that people there are particularly prone to believe scare stories—it is that they know exactly what is going on. They know that they are being punished for the failings of others at a time when Lewisham hospital has made every effort to meet the financial targets and, more particularly, the service targets, and to retain the confidence of local people.

I would therefore say this to anybody whose local trust is performing badly: fear not, for under this Government you will be rewarded. What people really need to be careful of is being anywhere near a trust that is doing badly, because even though their local trust may be doing well, the Secretary of State will appoint his henchmen—and women, for that matter—to go in there, jackboot their way around the place, spend millions of pounds of public money, and then come up with a scheme that does not do much to achieve the purpose for which they were appointed but rather deals with others who have played the game and played by the rules: and under this Government, more fool them.

[Gavin Barwell (Croydon Central) (Con)]

I have quite a bit of sympathy with some of the points that the hon. Gentleman is making because some of my constituents work at Lewisham hospital and have contacted me about this issue. However, he has to make his argument in a balanced way. Is it not the case that under the previous Government, when there was a problem in one PCT neighbouring PCTs were required to subsidise it, and that that, to a degree, unfair as it seems to people, is the consequence of having a national health service rather than separate individual units?

[Jim Dowd]

No, that is not the case.

It is a question of whether being reasonable gets one anywhere. People in Lewisham have tried being reasonable with the trust special administrator and with the Department of Health, but so far it has got them nowhere, so they are having to consider other methods.

Just how many hospitals up and down the country are under threat is evident from the Members who are present this afternoon. In many cases, the accident and emergency unit is the heart of a buoyant and thriving hospital. So much else stems from the work of A and E units. My hon. Friend the Member for Barrow and Furness (John Woodcock) outlined the point that in many parts of the country outside London, it is as much a question of geography as the number of people because of the threat that people will have to travel great distances to get the treatment they need. A and E units have such a critical function that Professor Sir Bruce Keogh, the medical director of the NHS who has already been mentioned, has highlighted the scale of the problems across the country and, I am led to believe, is undertaking a review of A and E units.

I am somewhat less reassured by Sir Bruce’s view of democracy and the role of local representatives. He is not alone in holding that view. Many medical professionals and particularly administrators—Sir Bruce straddles both roles as he is an administrator and a clinician—believe that they should decide what is best for people and that people must put up with it. They believe that local representatives, whether they be Members of Parliament, local councillors or the local council, have no right to interfere. I have to say to Sir Bruce and the other professionals at the Department of Health who operate under that illusion, that that is not how a democracy works. In a democracy, people need to be persuaded that what is being done is in their best interests. If there is to be change, the result must be a system that is safer and more reliable than the one that it replaces. Simply turning to people in a patronising and condescending fashion and saying, “You don’t understand what we understand,” is not the way to treat the citizens of this country.

The threat posed by the unsustainable providers regime in the South London Healthcare NHS Trust is a threat to every single trust in the country. If the Government get away with the way in which they have conducted the regime in Lewisham, they will be able to do it anywhere. The whole scheme has been designed, promoted and decided on by the Department of Health without any objective external appraisal.

The objective of the exercise in the case of the South London Healthcare NHS Trust was to revive a dormant and defunct NHS London scheme to reduce the number of A and E units and functioning hospitals in south-east London from five to four. That plan was put before the previous clinically led review, “A picture of health”, and rejected. It was also rejected by the subsequent review of that review by Professor Sir George Alberti, who is now the chair of the trust board at King’s College hospital. The plan did not survive because it does not make sense on clinical grounds. What is happening now in south London is being done entirely on financial grounds.

Although Lewisham hospital is being devastated via this back-door reorganisation, the Secretary of State and his predecessor originally denied that it was a reconfiguration. Unfortunately, in his statement last Thursday, the Secretary of State confirmed that it was a reconfiguration. Had they been honest and straightforward and told the truth at the outset, there would have been an entirely different procedure, which would have been amenable to external review and would have had an appeals process. They would have had to stand up the case for the action that they are now contemplating. This situation has been engineered entirely by the officials and their acolytes within the fortress of Richmond house. All the clinical evidence that they have taken any notice of has been paid for. It has come from people who work at the Department of Health or people who have been brought in to the so-called clinical advisory group by the trust commissioner.

It is an irony bordering on contempt, not only for the people of south-east London, but for people from much further afield, that the trust special administrator who was brought in to save the overspending South London Healthcare NHS Trust overspent his own budget by more than 40%. The final bill is not yet in, but he has spent £5.5 million. All he did was take off the shelf a scheme that NHS London, while in its death throes—it has only a month or so before it is replaced—wanted to use. We need only look at the chronology to see that this is what was intended all along. The trust special administrator did not reach a conclusion; he started with the premise to shut down Lewisham hospital.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

Will the hon. Gentleman give way?

[Jim Dowd]

I certainly will; I need the extra minute.

[Anna Soubry]

Is the hon. Gentleman saying that the trust special administrator was given a brief and did not act independently? Does he recognise that he had two hospitals in PFI agreements that were losing £1 million of taxpayers’ money in those agreements—money that should have been spent on health services?

[Jim Dowd]

That is not true; we do not have that. That is in South London Healthcare NHS Trust. Lewisham Healthcare NHS Trust is in balance—[Interruption.] I am saying that a trust special administrator was given a remit to close Lewisham hospital. Why on earth were Lewisham Members invited to the meeting to discuss South London Healthcare back in July? This scheme has been hatched in the Department of Health, and the Minister does herself no credit by attempting to defend the indefensible.

--- Later in debate ---

[Mike Gapes]

I do not personally blame Averil Dongworth, the new chief executive at Barking, Havering and Redbridge University Hospitals NHS Trust, for the current situation. She has not been there long enough. There are a number of predecessors who were party to the proposal. I also blame Ruth Carnall and the people in NHS London who were behind the original proposals. They and Heather Mullin, along with others in the NHS in London, have been determined for six or seven years to close the A and E unit at King George regardless of the petitions, the protests or the fact that the public overwhelmingly rejected their proposal, even in their rigged consultation.

[Jim Dowd]

On the malign influence of NHS London, let me tell my hon. Friend that its policy director—one Hannah Farrar—was appointed as number two and chief assistant to the special administrator of South London Healthcare NHS Trust, precisely to achieve what had always been wanted: the closures at Lewisham.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I congratulate the hon. Member for Ealing, Southall (Mr Sharma), my right hon. Friend the Member for Newark (Patrick Mercer)—if he is not right hon., I am sure he will not complain at my saying that he is—and my hon. Friend the Member for Eastbourne (Stephen Lloyd) on securing the debate. It has been a good debate, if rather heated at times. There has been a great deal of passion, and rightly so. Fighting to defend our NHS and our hospitals in whatever way we need to is something that all Members should do. It is one of the reasons that we come here—to be champions of our local causes and to advance the cause of our constituents.

I apologise to the hon. Member for Lewisham West and Penge (Jim Dowd) if my intervention exacerbated his rising blood pressure. As the Minister for public health, I get concerned about his blood pressure, but he made it clear that he spoke with passion.

[Jim Dowd]

Will the Minister give way?

[Anna Soubry]

I have only about nine minutes, and I hope he will forgive me if I do not take any interventions. I will answer any points that he wants to raise in a letter or in any other way.

Yesterday, many of us took the view that we had seen one of the best moments in Parliament, when the Prime Minister rose to talk about the Francis report. It has been noted not only by Members but in the press and elsewhere that his statement and the responses of Members on both sides of the House were made without any finger-pointing, any blame or any party political point scoring. Many people think that it was a refreshing moment. I want to remind the House of what the Prime Minister said in response to an hon. Member’s question to him. He said:

“Let me refer again, however, to one of the things that may need to change in our political debate. If we are really going to put quality and patient care upfront, we must sometimes look at the facts concerning the level of service in some hospitals and some care homes, and not always—as we have all done, me included—reach for the button that says ‘Oppose the local change’.”—[Official Report, 6 February 2013; Vol. 558, c. 288.]

In quoting the Prime Minister, I pay tribute to the comments of my right hon. Friend the Member for Newark, my hon. Friends the Members for Banbury (Sir Tony Baldry) and for Croydon Central (Gavin Barwell) and the right hon. Member for Tottenham (Mr Lammy). These matters are not easy. My hon. Friend the Member for Croydon Central explained how he sat on one side of the fence, regarding the reconfigurations in his area, and in direct contrast to the hon. Member for Mitcham and Morden (Siobhain McDonagh). She is doing the right thing in talking about the needs of her constituents and fighting for them as she does, but that is an example of a reconfiguration in which two Members want to do their best but are effectively at odds. That is inherent in these sorts of changes, and in these concerns about the future of our accident and emergency services. Indeed, I have had meetings with my right hon. Friends the Members for Carshalton and Wallington (Tom Brake) and for Sutton and Cheam (Paul Burstow), because they too have views on the reconfigurations in their area, as we might imagine.

I want to set the record straight and make it clear that the reconfiguration of clinical services is essentially a matter for the local NHS, which must, in its considerations, put patients at the heart of any changes. As my hon. Friend the Member for Banbury said, the NHS has always had to respond to the changing needs of patients and to advances in medical technology. As lifestyles, society and medicine continue to change, the NHS needs to change too. The coalition Government’s overall policy on reconfiguration—if I have to repeat it, I will, to make it absolutely clear—is that any changes to health care services should be locally led and clinically driven. That is our policy, and those who seek to say otherwise do so in order to score cheap political points, which do them no favours whatever.

Let me turn, if I may, to the comments made in the excellent speech by my hon. Friend the Member for Newark, which was also touched on by the hon. Member for Hartlepool (Mr Wright). It is absolutely right and it is the case that there is confusion about the terminology. What does “urgent care” mean; what does “A and E” mean; how does it all fit in; where do we go? The hon. Member for Hartlepool made a very good point when he talked about the need for good public transport services to be part of any reconfiguration. I accept that.

I am pleased to say that on 18 January 2013, the NHS Commissioning Board announced that it is to review the model of urgent and emergency services in England. The review, which will be led by the medical director Sir Bruce Keogh, will set out proposals for the best way of organising care to meet the needs of patients. The review will help the NHS to find the right balance between providing excellent clinical care in serious complex emergencies, and maintaining or improving local access to services for less serious problems. It will set out the different levels and definitions of emergency care. This will include top-level trauma centres at major hospitals such as my own, the Queen’s medical centre in Nottingham —and here I hope that my hon. Friend the Member for Newark would accept that the journey to that centre down the A46 has added to provision for the great town of Newark. The definitions will be looked at and the review will take into account, as I say, the trauma centres at major hospitals, but also local accident and emergency departments and facilities providing access to expert nurses and GPs for the treatment of more routine but urgent health problems.

South London Healthcare NHS Trust

Jim Dowd Excerpts

Thursday 31st January 2013 Commons Chamber

[Mr Hunt]

I entirely agree with my right hon. Friend. It would be totally irresponsible for me as Health Secretary to fail to take a decision that could save as many lives as I believe this decision will save. If we are to save more lives in A and E and reduce the number of maternity deaths in London, it involves taking difficult decisions. The disappointment for me is that the Labour party has chosen to jump on an Opposition bandwagon, rather than putting forward its own solution to deal with the clinical issues in south-east London. Unfortunately, the Opposition are playing to the gallery. That is not what a Government-in-waiting should be doing.

[Jim Dowd (Lewisham West and Penge) (Lab)]

I start by congratulating the Secretary of State on admitting in his statement something that has been denied from the outset: that this is a reconfiguration. Indeed, it is a back-door reconfiguration.

I do not think that my right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock), my hon. Friend the Member for Lewisham East (Heidi Alexander) and I can adequately represent the outrage and anger of the people of Lewisham at the sheer unfairness of this proposal. The Secretary of State is wrong to say that Matthew Kershaw concluded that his review needed to go wider than South London Healthcare NHS Trust; he started from that premise and said so openly at the meeting in July at the office of the Secretary of State’s predecessor.

Is the Secretary of State aware that even the maternity proposal will mean that a double rota is necessary at King’s College hospital and Queen Elizabeth hospital Woolwich, because it will increase the expected annual number of births at both units to more than 8,000? That will lead to worse services and less choice for patients. The fact that it does not have the support of local commissioners does not seem to register with the Secretary of State.

Will the Secretary of State say whether it was really necessary to spend £5.5 million of taxpayers’ money to demonstrate that his four tests are meaningless and that the guarantees and undertakings of this Tory-Liberal Government are worthless?

[Mr Hunt]

First, let me say to the hon. Gentleman that this is a reconfiguration. However, the normal processes for reconfigurations have been suspended because of legislation that was passed by the Government who were in power until 2010 and whom he supported.

The trust special administrator, Matthew Kershaw, looked extensively at whether there was an option within South London Healthcare NHS Trust to solve the problem. He invited expressions of interest from other people who might run the hospitals in the group, but nobody was able to come forward with a proposal that would solve the problem within the geographical confines of the trust. Indeed, nobody—not the Labour party, nor any of the people who oppose these changes—has come forward with a proposal that would not impact on neighbouring health care economies.

The hon. Gentleman spoke about choice. Choice is not just about the number of hospitals that one could go to, but about the number of good hospitals that one could go to. Nowhere in south London currently meets the London-wide clinical quality standards. As a result of my decision today, the whole of south-east London will meet those standards and it will have some of the highest quality care in London for people who use A and E and maternity services.

On the cost of the process, £5.5 million is the cost of failure—the total failure of the last Government to address this issue when they could have done, rather than bequeath the highest deficit anywhere in the NHS.

--- Later in debate ---

[Mr Hunt]

Clinicians and commissioners have been closely involved in these proposals which, as the right hon. Gentleman will know from reading my statement, affect the broader south-east London area covering six clinical commissioning groups. Five of those groups support the proposals. One does not, but it supports the principles behind them, which is that more complex procedures must be carried out on fewer sites. We have had the benefit of the clinical input of senior people such as Sir Bruce Keogh, and many of the royal colleges have been involved in the external clinical advisory group, which had significant input on the proposals. One question I asked Sir Bruce was whether there had been sufficient clinical input, and his conclusion was that yes, there had been.

[Jim Dowd]

All paid for.

[Mr Speaker]

Order.

Hospital Services (South London)

Jim Dowd Excerpts

Tuesday 22nd January 2013 Westminster Hall

[Heidi Alexander]

The hon. Gentleman is, of course, referring to the four tests for service reconfigurations that his own Government have said must be met if changes are to be made. GPs in Lewisham are opposed to these changes, and they have been very vocal in making their case.

[Jim Dowd (Lewisham West and Penge) (Lab)]

I am most grateful to my hon. Friend for giving way, and I join others in congratulating her on securing this extremely timely debate. She said a few moments ago that she did not understand where this plan had come from. Has she considered that it is merely a rehash of the scheme that NHS London tried to get past the “Picture of Health” review four or five years ago but failed miserably, both in the review itself and in the subsequent re-examination by Professor Sir George Alberti, and that in its death throes—NHS London only has a few months before it is extinguished by this Government—it is trying to get through the scheme to reduce hospitals in south London from five to four, and for no other reason than that it thinks that that reduction should happen?

[Heidi Alexander]

My hon. Friend has a long history of working and campaigning on health issues in south-east London, and I agree with his analysis that the scheme that he refers to may have been one of the places from which these proposals for Lewisham hospital emerged. I said earlier that these changes are unwanted. In addition, I want to say today that they are also unfair, unsafe and unjustified. I will now take a few minutes to tell Members why that is the case.

Why are these proposals unfair? The closure of Lewisham’s A and E department and its maternity department has been recommended to the Secretary of State for Health by the special administrator to the South London Healthcare NHS Trust. In July last year, the special administrator was appointed to the trust, which is made up of the three hospitals to the east and south of Lewisham—Woolwich, Sidcup and Farnborough hospitals. The administrator’s job was to find a way to balance the trust’s books. It was the first time that a special administrator had ever been appointed in the NHS, and the first time that the unsustainable providers regime—that is, the process for sorting out failing hospital trusts—has been used anywhere in the country.

The trust had, and still has, serious financial problems. I should be clear: Lewisham is not part of the trust; nor does it share the trust’s financial problems. Lewisham hospital is a solvent and successful hospital. Its management has worked hard during the past five to 10 years to improve standards of care and to make the hospital more efficient. Yet, because Lewisham hospital is next to the South London Healthcare NHS Trust, because it has only a modest private finance initiative, so there are not as many constraints on the site as on the two big PFI hospitals at Woolwich and Farnborough, and possibly because of its location in relation to surrounding hospitals, the special administrator decided to recommend the closure of its A and E and maternity departments.

As I said, the draft proposals were published at the end of October. There ensued six weeks of the worst public consultation that I have ever seen. There was no direct mailing to the people affected, and there were opaque and complicated questions in the consultation document. There was not even a direct question about the closure of Lewisham A and E. To add insult to injury, there was no question at all about the sale of the land at the hospital.

Not only are my constituents up in arms about the so-called consultation, but they are rightly asking how Lewisham got dragged into this. Why does it have to pay such a heavy price for financial failures elsewhere? How can it be right that a process set up to sort out financial problems in a failing trust has led to services being cut at a separate, well-performing, financially stable hospital? I cannot answer those questions; nor can I explain why such a significant reconfiguration of emergency and maternity services is being proposed.

The statutory guidance to trust special administrators and the written statement that the former Health Secretary, the right hon. Member for South Cambridgeshire (Mr Lansley), made to the House when he enacted the special administration regime last summer clearly state that the process should not be used as a back-door approach to service reconfiguration. I laughed out loud when I read those words in the statutory guidance, because that is exactly what is happening in south London. If closing A and E and maternity departments is not a service reconfiguration, I honestly do not know what is.

--- Later in debate ---

[Jim Dowd]

On that very point, does my hon. Friend accept that the trust special administrator has deliberately manipulated the figures, in both the draft and final reports, to mask the fact that the proposal would push King’s at least and probably Queen Elizabeth hospital, Woolwich as well over the 8,000 births a year mark?

[Heidi Alexander]

I do not know whether the trust special administrator has deliberately manipulated figures, but the way that the figures have been presented looks quite suspicious.

The plans are completely unjustified. There has been much talk in recent weeks of the need for things to do what it says on the tin. The metaphorical tin with respect to the recommendations of the trust special administrator presumably says it will resolve the financial problems of the South London Healthcare NHS Trust and put the health economy in south-east London on a stable footing. I do not think the proposals before us do that. It will be necessary to spend £195 million on a one-off basis to make changes at hospitals in south London, to deal with the displaced demand for A and E and maternity care that will result from the closure of services at Lewisham. It is not clear to me where that money is coming from: which Department of Health budget is it to come from? Has the Treasury approved that non-recurrent expenditure? If it has not approved the required capital outlay, the plans fall apart. Perhaps the Minister can deal with that point.

The changes to the Lewisham site would involve demolition of the recently refurbished A and E, so that the land could be sold. Long after the A and E was knocked down, the hospital would still be paying £400,000 a year in loan repayments for the £12 million it borrowed to make the improvements. That is a bit like someone taking out a loan to do up their kitchen and knocking down that part of the house while still paying money back to the bank.

Another big question relates to the continuing year in, year out costs of the changes. The possibility of a double maternity shift at King’s and St Thomas’s, which I have mentioned, is just one example, and would surely add hugely to the bill. How much would it cost to implement a community-based care strategy to reduce the need for hospital services? Where is the money coming from?

If the proposed changes to A and E and maternity care in south-east London cannot be justified financially, do not result in better health outcomes and are unfair and unwanted, why on earth are we here to debate them today? The Government have consistently said that changes will not be made unless four specific tests are met, as my right hon. Friend the Member for Lewisham, Deptford and the hon. Member for Beckenham (Bob Stewart) have mentioned. In the present case, the tests are not met. The chair of the local commissioning group is opposed to the changes, as are virtually all Lewisham GPs. The process should result in strengthened patient and public involvement, but the current process has resulted in strengthened disillusionment among the public, and little else. Proposals should be based on a sound clinical evidence base—but the evidence base in the present case is virtually non-existent. It is also stated that the Government will not make changes to such major services unless doing so will strengthen and improve patient choice; the special administrator’s own report recognises that the proposals will result in a weakening of patient choice.

As I said earlier, the proposals are unwanted, unfair, unsafe and unjustified. Last week the NHS Commissioning Board announced a review of emergency care, to be led by the NHS medical director, Sir Bruce Keogh. I welcome that review, but what is the point of it if the Government are just going to push ahead with their proposals in south London? The chaotic handling of the process in Lewisham cannot be right. It rides roughshod over the wishes of the community and local clinicians. For the life of me, I cannot see how it is in the best interests of my constituents or the people of south London. I urge the Minister to reject these rushed and ill-conceived plans and to do as her party’s manifesto says:

“stop the forced closure of A and E and maternity wards, so that people have better access to local services”.

I am not asking for better access; I am just asking for the access that currently exists for people in Lewisham to be maintained.

--- Later in debate ---

[Jim Dowd]

Should I catch your eye later, Dr McCrea, I will address the four principles in more detail.

The right hon. Member for Bermondsey and Old Southwark (Simon Hughes) says that the Secretary of State’s predecessor set up the four tests, but does he not accept that one of the previous Secretary of State’s first acts just after the 2010 general election was to suspend the implementation of the “A Picture of Health” process that the South London Healthcare NHS Trust was undertaking? I am not saying that the process would necessarily have led to success, but its suspension undeniably made the trust’s task unbelievably more difficult.

[Simon Hughes]

I do not dispute that. I am not as close to the process as the hon. Gentleman. I did not follow those issues as closely, because the process did not directly affect my borough, although it directly affected his. I have taken advice from someone who has been involved over the years at Lewisham hospital and in NHS management, and the history of financial poor management in the South London Healthcare NHS Trust stretches back over 10 years. The advice I have received is that poor management should have been gripped seven or eight years ago, but the problems escalated. We are in our present position because of a legacy of poor decisions made over effectively a decade. Things might have been rescued by the Government at the beginning of this Parliament, but they clearly were not and we are left in our present position.

I have a few comments, and I do not want to take time from other colleagues who have a direct interest. I responded to the consultation to make clear the interests of my constituents. The Secretary of State invited those of us with an interest to see him, and we are grateful for that invitation, which we used, I hope, to put our case effectively. The right hon. and learned Member for Camberwell and Peckham and I, and those MPs whose constituents use King’s, have written to the Secretary of State further to that meeting to make clear our concerns about the impact on King’s of any closure of Lewisham A and E, irrespective of the change in maternity services.

There is an alternative approach, which I commend to the Secretary of State. I hope he understands the benefit of going down the alternative route, rather than following the trust special administrator’s recommendations. The alternative, which we explored at our meeting and which I do not believe was adequately answered by the trust special administrator or his colleagues, is that five of the six recommendations—excluding recommendation 5 on the site configuration—leave open the option of amalgamating NHS management between Lewisham and Greenwich. NHS management could then be allowed to work out the best configuration of services across the two boroughs in consultation with, and with the confidence of, the local authorities in question, which now have direct responsibility through health and wellbeing boards under the Health and Social Care Act 2012, and in conjunction with GPs to seek GP commissioning endorsement and support. I hope there would be much more public support than for the present proposal, as is understandable.

I hope that the Secretary of State will find that to be an appropriate solution. It may have a small financial disadvantage over the present proposals but, as the hon. Member for Lewisham East said in her speech and as she and her colleagues from Lewisham have made clear in their letters to the Secretary of State, the TSA’s figures show a financial gap of only £1.7 million from a break-even position if recommendation 5 were not to be followed, compared with a financial gap of £75.6 million if the recommendations were followed. There are knock-on effects, but we seem to be talking about a sufficiently small amount of money, with little risk of any other financially adverse impact, and if people are motivated to reach a conclusion quickly, that must be a much more satisfactory way of proceeding and much more in line with the four tests set out.

--- Later in debate ---

[Jim Dowd (Lewisham West and Penge) (Lab)]

I will attempt to be brief, Dr McCrea, given your exhortation and out of consideration for my colleagues.

I do not think that the Secretary of State for Health will proceed with the proposed plan, because it is so far off the rails. It is such a ludicrous proposition, so ridiculous in its scope and even its intent and such a shoddy piece of work, frankly, that the Secretary of State will not be so foolish as to proceed with it, even if he can blame his predecessor for lumbering him with it. We have to recognise the threat, however, and to do what we can to make the case against it. That is why, after 10,000 people turned up on the 24 November to march past the hospital to protest against the plan to downgrade—to eviscerate—Lewisham hospital, rather more will be out again this Saturday, marching past the hospital to Mansfield park in Catford, to express what my hon. Friend the Member for Lewisham East (Heidi Alexander) described as anger, although I go beyond that.

My hon. Friend was kind enough to mention that I have been in this place 20—now almost 21—years, but I was also involved with Lewisham council for 20 years before I came here, and, without doubt, the hospital proposal has raised more fury than anger—more so than any other local issue in all the 40-plus years that I have been involved in public life in Lewisham, even more than the madcap scheme of the Department for Transport under the now Lord Parkinson to further the south circular assessment study. That scheme had recommended widening the south circular to six lanes throughout, with eight lanes in some parts, right the way through the middle of Lewisham. People thought that was mad enough, but that pales into insignificance compared with the public response to the proposals that we are discussing.

What fuels the fury is not the incoherence of the plans, or even the gross financial assumptions—I have heard people call them heroic, but some of the claims are lunatic, and in pursuit of so little—but the sense of injustice, the unfairness of the scheme. Lewisham hospital, as in the recent past, has a strong commitment to safety, quality and patient experience. It has been rated in the top 40 hospitals nationally by CHKS—for clinical effectiveness, patient safety and so on—and has a strong record in achieving national and local performance targets. It is operationally lean, the reference costs index making it the most efficient trust in south-east London, delivering financial surpluses in each of the past six years—Guy’s and St Thomas’s trust, King’s College trust and, obviously, the South London Healthcare NHS Trust have not done that.

Our hospital has achieved the successful integration of acute and community services, fostering strong links with social care, and the people of Lewisham are already reaping the benefits. It has the reputation for strong and successful partnerships, so much so that many of the people at the Queen Elizabeth look forward to Lewisham management taking over to build links with commissioners, local GPs, the local authority, patients and staff.

Lewisham hospital, or University Hospital Lewisham, now part of the Lewisham Healthcare NHS Trust, with NHS London’s encouragement, was actively pursuing a foundation trust application when the process we are discussing interrupted and completely derailing that application. People are furious at the injustice precisely because Lewisham hospital has done everything in the services that it provides that could reasonably be expected of it by the Department and particularly by the people of Lewisham.

I want Lewisham hospital to survive as an institution, but I am not desperately keen on institutions for their own sake, important as they are. I am more interested in the services that they provide for the people they serve, and the hospital’s record is exemplary. To see that destroyed and devastated by the vandalism of the trust special administrator process is more than most reasonable people can stand or accept.

I have been inundated, as I am sure have my colleagues, with information from various quarters, and all has been hostile. One note from a constituent—I will not be too specific as I do not want to identify her, but she is a clinician at Queen Elizabeth hospital—who did not support the closure but does not want Lewisham hospital to be destroyed, said that the position at Queen Elizabeth hospital is dire, and needs strong leadership and a clear sense of direction and purpose, so that it too can provide the services that the people of Bexley, Greenwich and Bromley deserve. If the closure of A and E at Lewisham hospital goes ahead, 750,000 people in Bexley, Greenwich and Lewisham will have a single A and E department available. That would not be safe by any stretch of the imagination.

I can do no better than to quote an e-mail that I received just yesterday from the GP team in neighbourhood 4 of the Lewisham general practitioners clinical commissioning group that makes the case well. The group covers practices in Bellingham Green, Sydenham Green, Sydenham road, the Vale, Wells Park in Woolstone road, and the Jenner, which is in the constituency of my right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) and just the other side of the south circular road on the boundary between our constituencies. It says that closing

“the A and E will hit the elderly, disabled…and children of single parents disproportionately”

and that

“although an urgent care centre…will persist, its use its use will decline significantly as neither patients nor clinicians will have confidence to use an UCC unsupported by acute medical and surgical care”.

My right hon. Friend made that point elegantly. The e-mail continues:

“Loss of obstetric service will result in women in labour having to attend a different provider from their antenatal care, few women will choose this option, as both patients and clinicians are aware of the increased risk of disjointed maternity care and find it emotionally unsettling.”

It also says:

“The projected flows of patients are inaccurate and therefore so are the costings, our Primary Care survey across Lewisham showed 80%+ of patients would attend Kings, 10% St Thomas, 6%”

Princess Royal university hospital, Farnborough, and that only 4% of those currently attending Lewisham A and E would go to Queen Elizabeth hospital at Woolwich.

[Bob Stewart]

The point about going to Farnborough is that it is a heck of a long way from Lewisham, which makes it difficult. Public transport to Farnborough is not acceptable for people who are weak, disabled or poor.

[Jim Dowd]

I am grateful to the hon. Gentleman. He knows that many of his constituents attend Lewisham hospital, so the effect will be not just on people who are resident in Lewisham.

In view of the time, I will not go through the rest of my points, but suffice it to say that they are compelling, overwhelming and make sense. The problem with the trust special administrator is that he regards antagonism and opposition from local people, particularly clinicians, as a sign of his rectitude. One of our local football teams is Millwall, which is based in Lewisham, although the right hon. Member for Bermondsey and Old Southwark (Simon Hughes) prefers to disguise that fact. It has an unofficial slogan, which is also a song to the tune of “Sailing” by the Sutherland brothers and was made famous by Rod Stewart. The words are:

“We are Millwall, super Millwall”

and

“No one likes us, no one likes us

No one likes us, we don’t care!”

I suspect that Mr Kershaw has taken that local aphorism as his inspiration because he could not have gone further out of his way to antagonise all the people of south-east London. The problem is that most Millwall football fans sing it as a joke, but Mr Kershaw clearly believes it. He has succeeded in antagonising and alienating not just the medical community, but everyone in south-east London, because the whole scheme is a shambles. He said that no one came forward with a viable alternative to his plan, which is why the final report is as it is. I can tell him that if they had £5.2 million and rising and the services of McKinsey, Deloitte, Ipsos MORI and other consultants, year 6 at Dalmain road primary school could have come up with a better scheme than his. I suspect that the Secretary of State has enough sense to reject it. Action needs to be taken to secure health services across south-east London, but this is not the way.

[Clive Efford (Eltham) (Lab)]

It is a pleasure, Dr McCrea, to speak under your chairmanship. I congratulate my hon. Friend the Member for Lewisham East (Heidi Alexander) on securing this important debate. I want to start by defending South London Healthcare NHS Trust. Its financial difficulties are enormous and there is no disguising that, so people have tended to roll up its performance into something that is failing on all fronts, but that is clearly not the case.

When the hospitals—Bromley hospital, Princess Royal University hospital, Queen Elizabeth hospital in Woolwich and Queen Mary’s hospital at Sidcup—were merged approximately four years ago into one healthcare trust, there were serious difficulties with clinical performance, but very quickly the trust improved its performance significantly, and so much so that it was one of the best performing on many indicators. That is why it was so sad that when the trust was put into administration, unattributable sources in the Department of Health put out rumours that that was about not just financial mismanagement, but the fact that standards of care were failing. That was completely and utterly untrue.

I go back several years, and I am on my fifth chief executive at my local hospital. All have gone through the same scenario as Mr Kershaw, and all have given me assurances about the areas—I will not go into them because I do not have enough time—where financial performance needed to improve and efficiencies needed to be made. Always, they made the point about the need to treat people close to where they live in the community and reduce pressure on acute services.

All have made that point, and all have needed to improve clinical performance. Just over a year ago, the South London Healthcare NHS Trust had only one case of blood-borne MRSA, which was the best performance in the country. The improvement in the quality of care under the new trust was significant indeed. Waiting times in A and E improved, and Dr Foster reported on a significant and consistent improvement in the standardised mortality ratios over a couple of years. On those performance indicators, it outperformed Lewisham hospital.

When the decision was made to put the trust into administration, its performance on quality of care for local patients was improving. Anyone who was concerned about care for local patients would have worked through the financial difficulties with the trust. It was a big ask in that short period to improve clinical performance as it did, to merge the hospitals as it did, and to improve financial performance as it was required to do. It was always a big ask, and I think it was impossible. That should have been recognised, and the Government should have worked with that hospital trust to work through those difficulties.

We all know that PFI has not caused this problem, but it has added to it. PFI accounts for roughly a third of the deficit, which is not to be ignored, but one issue that has come to light recently, in relation to PFI in general—not just in relation to South London Healthcare NHS Trust—is the effect that the manipulation of LIBOR has had on the rates that hospital trusts have had to pay, in terms of interest, as a consequence. I do not expect the Minister to have an answer to this question, but will she go away and consider what the cost implications of LIBOR manipulation have been for every PFI in the NHS? Are the Government considering taking legal action to retrieve any of that money, as is being considered in the USA?

I am conscious of time and I want to let the hon. Member for Beckenham (Bob Stewart) speak, so I shall move on. As has been said, the recommendations fail several tests, and they clearly fail the test of satisfying local GPs and receiving local GP support. The chair of the local GP commissioning body, Helen Tattersfield, wrote an article in The Guardian under the headline: “GPs are already wise to the scam of new commissioning groups”. She absolutely lampooned what is being proposed by the Government.

[Jim Dowd]

Does my hon. Friend realise that the Government have shifted ground on that? In the response that the Prime Minister gave to my hon. Friend the Member for Lewisham East, he said that the first test was

“the support of local GPs.”—[Official Report, 31 October 2012; Vol. 552, c. 230.]

However, the Secretary of State’s written statement, following the publication of the final report said that the first test was “support from GP commissioners”. The word “local” has disappeared, and what the TSA is trying to do is claim the support of commissioners from outside Lewisham to meet that test.

[Clive Efford]

The point made by my hon. Friend is self-evident, but if I may, I will not be drawn down the road, because I want to get the next point on record.

Lamenting the fact that local commissioners have not been listened to, Helen Tattersfield says in her article:

“No argument has any weight, however, against the needs of a failing trust, foundation trusts and potential private companies eager to expand their areas of influence, and NHS managers convinced of the merits of their model of fewer larger hospitals. Those of us who have spent hours acquiring the skills supposedly to lead commissioning have been shown that, in fact, decision-making and influence remains where it always was: with central managers, computer-derived models and reasoning that takes no account whatsoever of human behaviour in real life. We are little more than window-dressing for central planning geared to the needs of large foundation trusts, and open to the interests of the private sector.”

That comment alone just about sums up where we are.

I will finish soon to allow the hon. Member for Beckenham to speak, but I just want to ask the Minister whether she will consider a review of proposed A and E closures across London. We are seeing a piecemeal, salami-slicing of A and E services, which is putting the safety of Londoners at risk. As we know, we have seen a 50% increase in people waiting in ambulances for 30 minutes or more outside A and Es to gain access, and we have seen a 26% increase in those waiting for 45 minutes. We know that they are under pressure, so before we see any closures, that review must take place.

We can pray in aid what the Lord Chancellor and Secretary of State for Justice said. The headline on the relevant article read: “Hunt faces Cabinet split over A and E closure after Justice Secretary blasts plans as ‘sticking two fingers up’ to patients”. We also have the right hon. Member for Sutton and Cheam (Paul Burstow)—the former Minister of State, Department of Health—who lamented, when he was still a Minister, the proposed closure of St Helier:

“This is a flawed conclusion from a flawed process. There is still a lot of water to flow under the bridge before final decisions are made. The panel have ignored the pressure on all the A and Es and maternity units in south west London.”

We can pray those people in aid to defend our A and Es, and the Government should go back and look again.

To make one last point, we have seen the closure of an A and E, despite the promises of local Conservatives. The Leader of the House of Commons, when he was shadow Secretary of State, was going to save the A and E at Queen Mary’s, Sidcup, but it never came about. Under “A Picture of Health”, there was a proposal to have overnight stay, elective surgery at that hospital. It was promised to my constituents, who welcomed it and wanted to see it. I ask the Minister to reconsider removing that planned service from that hospital, because it was beginning to work and people welcomed it. It will be a serious cut to the quality of health care.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

As ever, it is a great pleasure to serve under your chairmanship, Dr McCrea. I congratulate the hon. Member for Lewisham East (Heidi Alexander) on securing this debate. I have about 10 minutes to respond to all the points. In the normal terms of any debate, there is an airing of conflicting views, different ideas and different points of views, but today there has been no such disagreement; we have had an outbreak of complete agreement among all the speakers and all those who have intervened. Everyone who has spoken this morning has done so with great passion and sometimes with ferocity in defence of the maternity unit and the A and E department at Lewisham hospital.

Let me make it absolutely clear that we are not in this position because of a Government decision or proposal, or as a result of some set of Government cuts. I made that same point a couple of weeks ago in an Adjournment debate that was called by the hon. Member for Lewisham West and Penge (Jim Dowd). I hope that those in the public domain who report these matters make that point very clearly, too. Anyone who seeks to make political capital out of this exercise does so at their peril, because, in many ways, this transcends party political divide and should not be used for party political advantage.

The trust’s special administrator published his report on 8 January, and a decision will be made by the Secretary of State for Health on 1 February.

[Jim Dowd]

rose—

[Anna Soubry]

Will the hon. Gentleman wait one moment, because it is extremely important that I put this on record? The Secretary of State will consider whether to accept the recommendations of that report and will reach a decision by 1 February. As a result of that, bizarre as it may seem to those who do not know the House, I am in some sort of peculiar purdah where I am not allowed to give any opinion of my own. It might be that that is a good idea, I know not, but those are the rules and I stick by them. I am not in a place, as the hon. Member for Denton and Reddish (Andrew Gwynne) well knows, to be able to say whether or not the four tests have been satisfied or, as I have said, to give my opinion. Sometimes, it is extremely difficult for an MP such as myself not to give an opinion.

--- Later in debate ---

[Anna Soubry]

I agree. In such cases, it is imperative that a decision is made sooner rather than later. What is most important—

[Jim Dowd]

rose—

[Anna Soubry]

I have not finished my sentence; do forgive me. What is most important is that the right decision is made after careful consideration. I am pleased that the Secretary of State was true to his word and had a meeting with Members who are rightly concerned about the future of Lewisham hospital on 14 January. I know that it was effectively a listening exercise, because he could not express an opinion. That meeting was held with Matthew Kershaw, who is the TSA, and his officials.

[Jim Dowd]

The Minister mentioned that a decision is to be made on 1 February, which is a sitting Friday. Statements can be made on a Friday, as we saw with the urgent matter last week. Sometimes, statements about issues relating to London can be made, but will the Minister accept that this is an issue of national import? Will she prevail on the Secretary of State to ensure that, whenever the statement is made, it is not on Friday 1 February? Will she give us that assurance now, or seek one from the Secretary of State?

[Anna Soubry]

That is a good point well made. I will ensure that the Secretary of State is fully aware of the hon. Gentleman’s views.

Why are we in this position? That was a question posed by the hon. Member for Lewisham East. Let us be absolutely clear about it. South London Healthcare NHS Trust has six PFI schemes. It is not as simple as putting all the blame on the PFI schemes, as some Members have suggested. The two largest schemes are at the Princess Royal university hospital in Bromley with a £30 million PFI scheme, and at Queen Elizabeth hospital in Woolwich with a PFI scheme of £29.1 million. The PFIs were signed off in 1998, but they certainly do not help the situation.

The trust is losing £1 million of public money a week. That £1 million could be better spent on improving and providing services to all whom these trusts seek to serve. This is a trust that has a £65 million deficit, the largest in the country, so doing nothing is not an option. No Government of whatever political colour would stand by and see the haemorrhaging of £1 million a week. When hon. Members gather again on Saturday for their protest, I hope that they make it absolutely clear to all the good people who attend to support their local hospital that that is the real financial situation. Often, when faced with such realities, difficult and tough decisions have to be made. The simple truth is—and I am sure that the hon. Member for Lewisham East will agree with me—that we cannot continue to have that haemorrhaging and a deficit of £65 million.

Unsustainable Provider Regime (NHS)

Jim Dowd Excerpts

Wednesday 28th November 2012 Commons Chamber

[Jim Dowd (Lewisham West and Penge) (Lab)]

I am delighted that Mr Speaker has seen fit to grant me this opportunity to raise a matter of considerable importance—in fact, the dominant issue—for my constituency and a large part of south-east London at the moment. The title on the Order Paper is “Unsustainable provider regime and special administration in the NHS”; and I will refer to all the special administrators appointed in the past, as there is only the one.

Last Saturday, along with thousands of other people, I was marching through the centre of Lewisham in the rain with my parliamentary colleagues, my right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) and my hon. Friend the Member for Lewisham East (Heidi Alexander)—they would have liked to be here this evening, but are attending other events relating to the same issue—to Ladywell fields just behind Lewisham hospital.

My experience of marches goes back quite a long way—I have been on a fair number of them in my time—but three factors made this march strikingly different from the usual ones. First, the majority of the marchers were ordinary residents and their families. Secondly, the motorists who were being held up by the march were, more often than not, tooting their horns to show their support for it. Thirdly—I had rarely seen this before—people were joining the march along the way, some of them with young children.

That march took place under the auspices of the Save Lewisham Hospital campaign. The reason for it was that, last July, the then Secretary of State appointed a trust special administrator—to whom I shall refer from now on as the TSA—for the South London Healthcare NHS Trust, under the unsustainable provider regime provided for by the National Health Service Act 2006. The three principal hospitals in the trust are Queen Elizabeth hospital in Woolwich, Princess Royal University hospital in Farnborough, and Queen Mary’s hospital in Sidcup. You will have noted, Madam Deputy Speaker, that Lewisham hospital is not part of the trust for which the TSA was appointed. However, far the most damaging proposals are those that affect that hospital.

The proposals are to close the accident and emergency department, which currently sees more than 120,000 attendances a year, to remove the maternity unit altogether—last year there were 4,500 births there, and the number has been projected to rise to 5,000 in the coming year—and to remove all the medical beds. If these plans were to see the light of day, there would be only one fully functioning accident and emergency unit to serve the three quarters of a million people who live in Bexley, Greenwich and Lewisham. Although there is scope for Lewisham to merge with Queen Elizabeth at Woolwich, it should not be necessary to pay such an extortionate price in terms of services for the people of Lewisham. It is rather as if the administrator for Comet—who, sadly, is having to do his work at the moment—were to decide that the best thing to do for Comet was to shut Currys down. The problem does not lie in Lewisham; it lies in the South London Healthcare NHS Trust.

It is not just the proposals themselves that are making people so angry; it is also the devious and underhand way in which they are being enacted. The last Secretary of State made a written statement last July, when he appointed the TSA. Before that, however, one of the first acts that he had undertaken as Secretary of State, just after the general election in May 2010, was to stop changes that were already taking place for the revitalisation of the South London Healthcare NHS Trust. He had put them on hold, without offering any alternative to a plan that had already been in place for a number of years; the last time the Government reviewed the services was four years ago. Having stopped those changes in their tracks, he then had the temerity to say, when he came to appoint the TSA, that not enough progress was being made to rebalance the trust’s finances.

In his written statement in July, the then Secretary of State said:

“The trust special administrator’s regime is not a day-to-day performance management tool for the NHS or a back-door approach to reconfiguration.”—[Official Report, 12 July 2012; Vol. 548, c. 48WS.]

However, that is exactly how it feels and looks in south-east London. There is a widespread feeling, backed by legal opinions, that the TSA does not have the power under the 2006 Act—and the current Secretary of State confirmed during Health questions yesterday that that was the legislation involved—to enforce his recommendations. Yet a “chief executive designate”, whatever one of those might be, is already working for the putative but non-existent joint Queen Elizabeth and Lewisham hospital trust.

The ultimate agreement of the Secretary of State seems to have been taken for granted—unless, of course, his authority is so ill-regarded that it does not matter what he thinks. However, the problem is not with the link between the University Hospital in Lewisham and Queen Elizabeth in Woolwich; rather, it is the intolerable price that the people of Lewisham are being expected to pay in terms of poorer, less accessible and more inconvenient services.

Let us contrast how Lewisham is being treated with how the other hospitals in the group are being treated. The TSA has suggested Queen Mary’s Sidcup should do a deal with Oxleas NHS Foundation Trust, and that is apparently going through without any great problem. The TSA also recommends that King’s College Hospital NHS Foundation Trust should take over the Princess Royal in Farnborough, even though no details whatever have been seen on how King’s would manage the Princess Royal. The arrangements for Lewisham are, however, prescriptive and take up much of the TSA report—and we must, of course, bear in mind that Lewisham hospital is not even part of the same trust.

The most damaging recommendation is that the A and E department at Lewisham should close, followed closely by the proposal to close all maternity services. A little booklet that the trust special administrator has put out says:

“Clearly this recommendation proposes change for University Hospital Lewisham. However, this is less than some may initially think. Based on analysis done by the Trust, it is expected that nearly 80% of patients who currently visit University Hospital Lewisham’s A&E would still be treated at the urgent care centre there in the future. This recommendation is not about ‘closing’ an A&E department but rather making changes to it.”

That is not what happened just over the river at Guy’s when its A and E was closed a few years ago, and it is certainly not what happened when the A and E at Queen Mary’s Sidcup was closed four years ago.

It is also certainly not what the emergency department doctors at Lewisham had to say. Their submission to the trust special administrator states in respect of the

“assumption that 77% of our ED patients can still be seen in the UCC”—

urgent care centre—

“in future: patients in the UHL UCC are seen by combination of”

practice nurses

“GPs and ED doctors between 0800 and 2400hrs…This means patients are seen in our UCC department with problems far greater than those that can be handled in a typical UCC. A standalone UCC will not be able to handle the number or acuity of patient that we presently see…Quite clearly, the 77% figure you have employed is not representative of any realistic future modelling…On review of our case mix, by our estimation at most only 30% of the total attendances to the present-day combined ED and UCC could be safely managed in a standalone UCC.”

That is the view of professional doctors. The TSA’s view is that of a civil servant. We do not need to be terribly perceptive to work out which we should place the greater store by.

The conclusion of the emergency doctors’ statement encapsulates the issue. They state that the TSA suggests that 30% of current presentations will, by some completely magical and invisible formula, be treated in the community, but that has not been achieved anywhere else in the UK and there is no evidence to support the assertion. The TSA is not so foolish as to try to adduce any. Nothing in the report or any of its appendices show how this 30% figure, which represents almost 40,000 people presenting at Lewisham A and E, will be dealt with. Their conclusion is:

“Feedback from our patients, the public and colleagues such as the London Ambulance Service (LAS) tells us that this ED”—

emergency department—

“is incredibly well regarded, and that the public and LAS choose to come here. We believe the implications of this proposal are extremely serious and will detrimentally affect the care and service that is offered to our local community. Concerns over how our patients will be able to access acute services at QEH, and the inevitable impact on an overstretched LAS, have also not been adequately addressed.

It is our opinion that as the draft report has been based on demonstrably incorrect figures and assumptions, its findings cannot be relied upon. An issue as important as the acute care of patients in South-East London cannot be determined by a hasty and flawed process, which was never designed to be used to reconfigure NHS services.

We have no objections to change, and strongly support all moves that propose the safe and effective care of patients. Thus we strongly urge that the proposed merged trusts (QEH and UHL), the local GPs and the wider public be left to decide at a local level how our services should be reconfigured. This would not only be safer and more considered, but would also be in line with the Government’s ethos of greater local control with a patient-centred approach to healthcare.”

That is signed by the four emergency department consultants, including the clinical lead, the two emergency department matrons and the emergency department nurse consultant. Hon. Members would have to agree that that is a damning indictment of what the TSA has been proposing.

As I have just demonstrated, the report’s assumptions, such as they are, are inaccurate, and the figures—even the financial figures—are completely unreliable. The TSA suggests that there is a £1.7 million saving to the Beckenham Beacon, the former Beckenham hospital which is now an urgent care centre predominantly occupied by GPs, but with the support of secondary and ancillary services. The TSA states that £1.7 million can be saved on what the South London Healthcare NHS Trust currently rents at Beckenham Beacon. This is right on the boundary of my constituency and that of the hon. and gallant Member for Beckenham (Bob Stewart); his constituency is on one side of the Croydon road and mine is on the other. People in the area were clearly concerned about the effect on services, so I went to see the putative clinical commissioning group, which takes over next year. It said that it is determined to continue to provide a comparable range of services—it will not be exactly the same as what is there at the moment—that that £1.7 million was only provided to South London Healthcare NHS Trust by the primary care trust previously for commissioning services there and that the CCG will continue commissioning services there. I have asked for exactly what the services will be to be put in writing, but I was told that broadly the CCG will be spending the same. So there is no saving to be had.

All the TSA is saying is that as South London Healthcare NHS Trust will cease to exist, it cannot pay any bills—so far, so bloody obvious. I would have thought it was not worth making the effort, but including this in the financial calculations demonstrates just how unreliable this report is. It is all smoke and mirrors. Given that it was carried out in such a short time and given that this system—the unsustainable provider regime—is not designed to deal with this degree of complexity, it is hardly surprising that it is such a shoddy and unreliable piece of work.

Why then be so prescriptive about what happens at Lewisham, given that in the case of the Princess Royal and Queen Mary’s an altogether more relaxed view is to be taken? The answer can be found on page 41 of the report. I will not wave it at you, Madam Deputy Speaker, but take my word for it. It contains a map of the Lewisham hospital site and it shows that the TSA wants to sell more than two thirds of the whole site. That would leave one building for hospital purposes and one building currently used by South London and Maudsley NHS Foundation Trust, which deals with mental health, so that the rest of the site can be sold off. Doing that will only raise between £17 million and £20 million, but it will close off the options. Once that has been done, Lewisham hospital can never be resuscitated, resurrected or whatever other language we might care to use. To enable the rest of the site, which includes a £12 million redevelopment of accident and emergency and maternity services that was only completed in 2010, to be cleared the TSA suggests that an additional £55 million will need to be spent on extending the riverside block.

The whole riverside block to which the TSA refers was only built six years ago under the private finance initiative and is working pretty well. The whole building only cost £70 million, and the TSA is proposing that £55 million should be spent so that the rest of the site can be cleared and sold for less than £20 million. That is almost unbelievable—it does not make any sense whatsoever. I do not know what will come back from the consultation that is under way.

Right across south-east London there are huge issues with acute services. I know that colleagues raised the matter in Health questions yesterday. The right hon. Member for Bermondsey and Old Southwark (Simon Hughes) mentioned the concern about Guy’s and St Thomas’, King’s, South London and Maudsley and King’s college, London—that is the university college, not the hospital—joining together to construct one of the largest trusts in the country. There is deep concern in Southwark and Lambeth about the impact that that could have on services. There is further concern, as I mentioned, in Lewisham, Bexley, Bromley and Greenwich about what else is going on.

I suggest that the Secretary of State parks the consultation. He should note what it says but launch a proper and legal clinical review of services across south-east London, as was conducted just four short years ago, when it was decided that Lewisham could stand on its own and provide decent services for the people of that area. I am not against improving services in Greenwich, Bexley or Bromley. Indeed, I represent the north-west part of Bromley, which sees Lewisham as its local hospital. However, what I cannot see—the TSA cannot convince me of this—is how degrading the services for people in Lewisham benefits anybody. It will not improve the services in Greenwich, Bexley or Bromley, so what is the point?

On 31 October, my hon. Friend the Member for Lewisham East asked the Prime Minister to recall that in 2007 he said that he would be prepared to get into a “bare-knuckle fight” over 29 assorted hospitals, one of which was Lewisham, to protect their A and E. I can tell the Prime Minister that he is in a bare-knuckle fight now over the future of A and E at Lewisham. The fight for Lewisham goes on.

Lewisham hospital has been threatened before, but the people of Lewisham have always fought to save it and they always have. They will again. In his reply to my hon. Friend, the Prime Minister said—this gives me some hope—that

“there will be no changes to NHS configurations unless they have the support of local GPs, unless they have strong public and patient engagement, unless they are backed by sound clinical evidence and unless they provide support for patient choice.”—[Official Report, 31 October 2012; Vol. 552, c. 230.]

I am confident that Lewisham will survive this, because none of those factors is in place at the moment, nor does this process have any legitimacy.